TRHC H-Logo

Claims Management - Sr. Analyst, Regulatory

Virtual Req #912
Wednesday, May 25, 2022

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
 

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

 

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are.  Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.

Job Description:                     Senior Regulatory Analyst  

                  

Summary: Under the supervision of the Director Compliance & Regulatory, the Senior Regulatory Analyst  is responsible for the oversight of all required reporting to CMS for risk adjustment and Part D, and serves as the first point of contact for clients with concerns/questions in these areas.

 

Essential Functions:

 

Regulatory Reporting

  • Reviews and analyzes internal and client regulatory reports, and coordinates with responsible parties, to ensure compliance with applicable regulations
  • Manages the upload of client encounter and pharmacy files
  • Compiles regulatory submissions to CMS, and drafts monthly status reports to clients
  • Monitors/audits business practices to ensure ongoing compliance with Medicare submission requirements
  • Monitors relevant governmental bodies to identify changes in legislation/regulations
  • Provides training for Peak staff and clients on reporting, and any applicable changes to reporting
  • Develops processes so that new reporting requirements are implemented in a timely manner
  • Communicates regulatory changes and deadlines to Peak staff and clients

 

Medicare Part D Processing

  • Imports all pharmacy files
  • Generates and submits PDE files
  • Reviews rejections and submits corrections
  • Reports NDC corrections to pharmacy vendor
  • Downloads and reviews Acumen PDE monthly reports
  • Provides PDE attestations to clients
  • Completes Acumen PDE analysis packages
  • Generates the annual P2P Worksheet for upload to CMS
  • Audits Part A stays
  • Completes monthly Reserve Model for clients
  • Reviews HPMS memos for changes that impact Part D
  • Provides Part D training to clients and staff as needed
  • Manages the compilation of regulatory submissions to CMS, and drafts monthly status reports to clients

 

Supervision and Leadership

 

Additional Functions:

  • Prepares and maintains assigned policies and procedures, as requested; revises and recommends improvements as necessary
  • Assists with special projects, as requested
  • Communicates clearly and concisely, with sensitivity to the needs of others
  • Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
  • Maintains courteous, helpful and professional behavior on the job
  • Establishes and maintains effective working relationships with co-workers
  • Ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards
  • Follows all Policies and Procedures and HIPAA regulations
  • Attends training and seminars to maintain a current knowledge of regulatory requirements and Part D
  • Maintains knowledge and understanding of current Medicare regulations related to PACE Health Plan Management.
  • Maintains a safe working environment

 

Supervisory Responsibility:

 

Travel: Minimal travel, less than 10%, expected for this position

 

Knowledge, Skills and Abilities:

  • Educational requirements include a High School Diploma or equivalent. Requires three years of Health Plan Management experience in a Medicare Advantage organization. PACE Health Plan Management experience preferred.   
  • Knowledge and experience using current computer technology, and a strong knowledge of Excel, Microsoft Word and PowerPoint  
  • Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels 
  • Skilled in data analysis and problem solving using defined methodologies
  • Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency 
  • Ability to work independently with minimal supervision
  • Ability to independently follow through on projects
  • Ability to communicate professionally, clearly and effectively, verbally and in writing
  • Ability to prioritize effectively
  • Ability to consistently multitask

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.

Other details

  • Pay Type Salary